Race coefficients (RC) in equations to estimate glomerular filtration rate (GFR) have been highly questioned. We aimed to evaluate the performance of three equations, namely 2009 Chronic Kidney Disease Epidemiology Collaboration (2009 CKD-EPI), 2021 CKD-EPI, and European Kidney Function Consortium (EKFC) in self-reported Black and White Brazilians. Our cross-sectional study compared estimated GFR (eGFR) with 51Cr-EDTA measured GFR (mGFR) in healthy adults, patients with type 2 diabetes mellitus with or without chronic kidney disease (CKD), and in non-diabetic individuals with CKD. The performance of these equations was assessed using Bland–Altman plots, Lin’s concordance correlation coefficient (CCC), bias, P30, and P15 accuracy. Three hundred six White adults (aged 53 ± 17 years, 55

Background: The effect of a single isometric handgrip exercise (IHG) on blood pressure (BP) variability (BPV) has not been addressed. This randomized controlled trial evaluated the effect of IHG vs. sham on BPV and BP.Methods: Hypertensive patients using up to two BP-lowering medications were randomly assigned to IHG (4 × 2 min; 30% of maximal voluntary contraction, MVC, with 1 min rest between sets, unilateral) or sham (protocol; 0.3% of MVC). Systolic and diastolic BP were assessed beat-to-beat in the laboratory before, during, and post-intervention and also using 24-h ambulatory BP monitoring (ABPM). BPV was expressed as average real variability (ARV) and standard deviation (SD).Results: Laboratory BPV, ARV and SD variability, had marked increase during the intervention, but not in the sham group, decreasing in the post-intervention recovery period. The overall change in ARV from pre- to 15 min post-intervention were 0.27 ± 0.07 (IHG) vs. 0.05 ± 0.15 (sham group), with a statistically significant p-value for interaction. Similarly, mean systolic BP increased during the intervention (IHG 165.4 ± 4.5 vs. sham 152.4 ± 3.5 mmHg; p = 0.02) as did diastolic BP (104.0 ± 2.5 vs. 90.5 ± 1.7 mmHg, respectively; p < 0.001) and decreased afterward. However, neither the short-term BPV nor BP assessed by ABPM reached statistically significant differences between groups.Conclusion: A single session of IHG reduces very short-term variability but does not affect short-term variability. IHG promotes PEH in the laboratory, but does not sustain 24-h systolic and diastolic PEH beyond the recovery period.

Objective: The aim of this study was to carry out the translation and present the evidence of validity of the Brazilian version of the interRAI Emergency Screener for Psychiatry (ESP). Method: this is a cross-sectional study conducted in a municipal hospital in the metropolitan region of Porto Alegre, Rio Grande do Sul. A total of 161 patients were evaluated in the first 24 hours of emergency arrival using ESP. Exploratory factor analyses of the sections of the instrument and reliability analyses were conducted using Cronbach's alpha and McDonald's Omega. Results: the analyses suggested an appropriate structure to the purpose of the instrument, two sections containing two factors instead of the expected one-dimensional structure. However, sections with two factors have interpretability and theoretical consistency. The factors presented internal consistency. Conclusion: the Brazilian version of the interRAI Emergency Screener for Psychiatry (ESP) demonstrates adequate psychometric properties through the internal structure of the instrument. Future studies should investigate the relationship of the scores produced by the instrument with clinical diagnosis and with covariates relevant to mental health outcomes.

PURPOSE: Hypertension affects more than 60% of older individuals and is associated with reduced baroreflex sensitivity (BRS). Lifestyle interventions, such as exercise, are recommended to promote healthy aging. Exercise training improves autonomic modulation and BRS in varied populations but not in patients with severe autonomic dysfunction. Due to the scarcity of the literature in the context of older adults with hypertension, we aimed to evaluate BRS and autonomic modulation of elders exposed to lifestyle interventions. Our hypothesis was that the exercise intervention would be superior to a health education program in improving these variables. METHODS: In a secondary outcome analysis of the HAEL Study (NCT03264443), 34 older adults (mean age 67.7±7.0) with hypertension (mean blood pressure 142.3±22.5/78.8±12.6 mm Hg) and in use of anti-hypertensive drugs were randomized to one of two 12-week interventions: EXERCISE (a 3 days.week-1, moderate-intensity, 1h-long, combined exercise program based on walking/running and body-weight/elastic bands resistance exercises) and EDUCATION (a weekly health education program based on hypertension management). BRS, frequency-domain indexes of blood pressure and heart rate variability and time-domain indexes of heart rate variability were calculated pre and post interventions through a continuous beat-to-beat blood pressure signal acquired with a sampling rate of 1000Hz. RESULTS: Baseline values for BRS were 16.7±5.3 ms.mm Hg-1 for EDUCATION and 16.5±9.3 ms.mm Hg-1 for EXERCISE. BRS change from baseline and respective 95% confidence intervals were +0.1 (-4.7 to +4.9) ms.mm Hg-1 for EDUCATION and +1.4 (-1.5 to +4.4) ms.mm Hg-1 for EXERCISE (P=0.53). No differences were found in frequency-domain indexes of blood pressure variability and heart rate and time-domain indexes of heart rate variability. CONCLUSIONS: In elders with hypertension, no changes in BRS or autonomic control were induced by 12 weeks of either health education or exercise training. These subjects might present some degree of blunted responsiveness to interventions with characteristics similar to what we proposed in relation to autonomic control modulation.

Confirmação diagnóstica e avaliação de repercussão sobre órgãos-alvo são passos críticos na avaliação de pacientes hipertensos. Demonstramos a importância da aferição repetida da pressão arterial, do tamanho do manguito e da temperatura ambiente para o diagnóstico de hipertensão arterial. Cefaléia tem associação fortuita com pressão arterial, assim como epistaxe. A tradicional classificação de Keith & Wagener (KW) não tem paralelismo com a gravidade da hipertensão arterial. A associação entre anormalidades fundoscópicas isoladas e pressão arterial é fortemente influenciada pela idade dos pacientes. O método microdensitométrico, desenvolvido em nosso serviço em conjunto com a engenharia biomédica, pode aumentar a eficiência da fundoscopia em predizer eventos cardiovasculares. Os achados descritos demonstram a importância de se empregar adequadas rotinas diagnósticas de hipertensão arterial e contribuem para o esclarecimento de muitas falsas associações com hipertensão arterial. Unitermos: Pressão arterial, hipertensão arterial, medidas repetidas, temperatura ambiente, cefaléia, epistaxe, alterações fundoscópicas.

Objetivo: O objetivo do estudo foi realizar a traducao e validacao do interRAI Emergency Screener for Psychiatry (ESP). Metodo: Trata-se de uma pesquisa transversal realizada em um hospital municipal da regiao metropolitana de Porto Alegre, Rio Grande do Sul. Foram avaliados 161 pacientes nas primeiras 24 hs da chegada a emergencia utilizando o ESP. Foram conduzidas analises fatoriais exploratorias das secoes do instrumento e analises de fidedignidade por meio do alfa de Cronbach e Omega de McDonald. Resultados: as analises sugeriram uma estrutura adequada ao proposito do instrumento, sendo duas secoes contendo dois fatores ao inves da estrutura unidimensional esperada. Contudo, as secoes com dois fatores possuem interpretabilidade e consistencia teorica. Os fatores apresentaram consistencia interna. Conclusao: A versao brasileira da interRAI Emergency Screener for Psychiatry (ESP) demonstra adequadas propriedades psicometricas por meio da estrutura interna do instrumento. Estudos futuros deverao investigar a relacao dos escores produzidos pelo instrumento com diagnostico clinico e com covariaveis relevantes para os desfechos de saude mental. Palavras-chave: Servico hospitalar de emergencia; diagnostico; psicometria; evidencias de validade; transtornos mentais. Referencias: Rabinowitz T, Hirdes JP, Curtin-Telegdi N, Martin L, Smith TF. interRAI Emergency Screener for Psychiatry (ESP) assessment form and user’s manual. Version 9.1. Washington (DC): interRAI, 2013. Hirdes JP, van Everdingen C, Ferris J, Franco-Martin M, Fries BE, Heikkila J, et al. The interRAI suite of mental health assessment instruments: an integrated system for the continuum of care. Front Psychiatry. 2020 Jan 17; 20(926):1-30. doi: 0.3389/fpsyt.2019.00926.

Objetive: The aim of this study was to characterize the acoustic signal of silent tracheal aspiration in children with oropharyngeal dysphagia (OPD).Method: Thirty-two children with OPD were examined with combined digital cervical auscultation (DCA) and videofluoroscopic swallow study (VFSS). Power spectral density (PSD, in 1/Hz) of the acoustic signal from a sequential series of five liquid swallows was used for comparisons between children who silently aspirated and children who did not aspirate on VFSS. Fourteen children were excluded due to either DCA/VFSS artifact or non-silent aspiration (cough, choking).Results: The remaining 18 participants (median age 6years, range 2-12.8) were classified based on VFSS as aspirators (n=8) and non-aspirators (n=10). The PSD curve of aspirators presented an ascending pattern (1st vs. 5th deglutition: 695.2 vs. 4421.9 1/Hz), while the curve of non-aspirators was flat (1st vs. 5th deglutition: 509 vs. 463.4 1/Hz), with marked differences being observed from the 3rd measure onwards (p<.001). In this study, DCA was able to identify silent tracheal aspiration in children with OPD.Conclusion: This non-invasive technique identified aspiration by an increase in the PSD curve in aspiration sounds.

INTRODUCTION:Parasympathetic dysfunction may play a role in the genesis of arrhythmias in Chagas disease.AIM:This study evaluates the acute effects of pyridostigmine (PYR), a reversible cholinesterase inhibitor, on the occurrence of arrhythmias in patients with Chagas cardiac disease.METHOD:Following a double-blind, randomized, placebo-controlled, cross-over protocol, 17 patients (age 50±2 years) with Chagas cardiac disease type B underwent 24-hour Holter recordings after oral administration of either pyridostigmine bromide (45 mg, 3 times/day) or placebo (PLA).RESULTS:Pyridostigmine reduced the 24-hours incidence (median [25%-75%]) of premature ventricular beats-PLA: 2998 (1920-4870), PYR: 2359 (940-3253), P=.044; ventricular couplets-PLA: 84 (15-159), PYR: 33 (6-94), P=.046. Although the total number of nonsustained ventricular tachycardia in the entire group was not different (P=.19) between PLA (1 [0-8]) and PYR (0 [0-4]), there were fewer episodes under PYR in 72% of the patients presenting this type of arrhythmia (P=.033).CONCLUSION:Acute administration of pyridostigmine reduced the incidence of nonsustained ventricular arrhythmias in patients with Chagas cardiac disease. Further studies that address the use of pyridostigmine by patients with Chagas cardiac disease under a more prolonged follow-up are warranted.

INTRODUCTION:Spontaneous breathing with a conventional T-piece (TT) connected to the tracheal tube orotraqueal has been frequently used in clinical setting to weaning of mechanical ventilation (MV), when compared with pressure support ventilation (PSV). However, the acute effects of spontaneous breathing with TT versus PSV on autonomic function assessed through heart rate variability (HRV) have not been fully elucidated.OBJECTIVE:The purpose of this study was to examine the acute effects of spontaneous breathing in TT vs PSV in critically ill patients.METHOD:Twenty-one patients who had received MV for ≥ 48 h and who met the study inclusion criteria for weaning were assessed. Eligible patients were randomized to TT and PSV. Cardiorespiratory responses (respiratory rate -ƒ, tidal volume-VT , mean blood pressure (MBP) and diastolic blood pressure (DBP), end tidal dioxide carbone (PET CO2 ), peripheral oxygen saturation (SpO2 ) and HRV indices in frequency domain (low-LF, high frequency (HF) and LF/HF ratio were evaluated.RESULTS:TT increased ƒ (20 ± 5 vs 25 ± 4 breaths/min, P<0.05), MBP (90 ± 14 vs 94 ± 18 mmHg, P<0.05), HR (90 ± 17 vs 96 ± 12 beats/min, P<0.05), PET CO2 (33 ± 8 vs 48 ± 10 mmHg, P<0.05) and reduced SpO2 (98 ± 1.6 vs 96 ± 1.6%, P<0.05). In addition, LF increased (47 ± 18 vs 38 ± 12 nu, P<0.05) and HF reduced (29 ± 13 vs 32 ± 16 nu, P<0.05), resulting in higher LF/HF ratio (1.62 ± 2 vs 1.18 ± 1, P<0.05) during TT. Conversely, VT increased with PSV (0.58 ± 0.16 vs 0.50 ± 0.15 L, P<0.05) compared with TT.CONCLUSION:Acute effects of TT mode may be closely linked to cardiorespiratory mismatches and cardiac autonomic imbalance in critically ill patients.

Diabetic MedicineVolume 31, Issue 6 p. 761-762 Letters Effect of peripheral cholinergic stimulation on autonomic modulation in Type 2 diabetes with autonomic neuropathy: a randomized controlled trial A. D. Harthmann, A. D. Harthmann Exercise Pathophysiology Research Laboratory and Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, BrazilSearch for more papers by this authorW. I. B. P. Souza, W. I. B. P. Souza Exercise Pathophysiology Research Laboratory and Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, BrazilSearch for more papers by this authorE. L. Ferlin, E. L. Ferlin Biomedical Engineering Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, BrazilSearch for more papers by this authorR. S. Moraes, R. S. Moraes Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, BrazilSearch for more papers by this author A. D. Harthmann, A. D. Harthmann Exercise Pathophysiology Research Laboratory and Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, BrazilSearch for more papers by this authorW. I. B. P. Souza, W. I. B. P. Souza Exercise Pathophysiology Research Laboratory and Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, BrazilSearch for more papers by this authorE. L. Ferlin, E. L. Ferlin Biomedical Engineering Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, BrazilSearch for more papers by this authorR. S. Moraes, R. S. Moraes Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, BrazilSearch for more papers by this author First published: 03 March 2014 https://doi.org/10.1111/dme.12423Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume31, Issue6June 2014Pages 761-762 RelatedInformation

Arrhythmogenic effects of alcohol may be intermediated by its effects over heart rate variability (HRV). Most studies about the effects of alcohol over HRV were observational and did not explore the temporal influence of alcohol ingestion over autonomic modulation. The aim of this study was to verify if an acute ingestion of alcohol has a time-dependent influence over time-domain indices of HRV. The effect of the ingestion of 60 g of ethanol or placebo over autonomic modulation was compared in healthy men (35 per group), with 18–25 years of age, before and during 17 h after ingestion. Alcohol promoted a fall in the standard deviation of all normal R–R intervals, root mean square of successive differences, and percentage of pairs of adjacent R–R intervals differing by more than 50 ms and in two indices of the three-dimensional return map, by a period up to 10 h after the ingestion of alcohol, accompanied by an increase in heart rate. The indices returned to values similar of the control group 10 h after ingestion. The effects over HRV indices were attenuated by adjustment for heart rate. The ingestion of alcohol induces a broad cardiovascular adaptation secondary to vagal withdrawal and sympathetic activation that may be responsible for arrhythmogenic effects of alcohol ingestion.

Purpose: Patients with type 2 diabetes mellitus may present weakness of the inspiratory muscles. We tested the hypothesis that inspiratory muscle training (IMT) could improve inspiratory muscle strength, pulmonary function, functional capacity, and autonomic modulation in patients with type 2 diabetes and weakness of the inspiratory muscles. Methods: Maximal inspiratory muscle pressure (PImax) was evaluated in a sample of 148 patients with type 2 diabetes. Of these, 25 patients with PImax <70% of predicted were randomized to an 8-wk program of IMT (n = 12) or placebo-IMT (n = 13). PImax, inspiratory muscle endurance time, pulmonary function, peak oxygen uptake, and HR variability were evaluated before and after intervention. Results: The prevalence of inspiratory muscle weakness was 29%. IMT significantly increased the PImax (118%) and the inspiratory muscle endurance time (495%), with no changes in pulmonary function, functional capacity, or autonomic modulation. There were no significant changes with placebo-IMT. Conclusions: Patients with type 2 diabetes may frequently present inspiratory muscle weakness. In these patients, IMT improves inspiratory muscle function with no consequences in functional capacity or autonomic modulation.

Tursiops truncatus (bottlenose dolphin) is the best known of all marine mammals, being widely distributed in almost all the oceans in the world. In some regions, two distinctive forms, offshore and inshore, are recognized, with variations in color, size, and genotype of the animals (Hoelzel et al. 1998).

BACKGROUND:Blood pressure (BP) variability has been associated with cardiovascular outcomes, but there is no consensus about the more effective method to measure it by ambulatory blood pressure monitoring (ABPM). We evaluated the association between three different methods to estimate BP variability by ABPM and the ankle brachial index (ABI).METHODS AND RESULTS:In a cross-sectional study of patients with hypertension, BP variability was estimated by the time rate index (the first derivative of SBP over time), standard deviation (SD) of 24-hour SBP; and coefficient of variability of 24-hour SBP. ABI was measured with a doppler probe. The sample included 425 patients with a mean age of 57 ± 12 years, being 69.2% women, 26.1% current smokers and 22.1% diabetics. Abnormal ABI (≤ 0.90 or ≥ 1.40) was present in 58 patients. The time rate index was 0.516 ± 0.146 mmHg/min in patients with abnormal ABI versus 0.476 ± 0.124 mmHg/min in patients with normal ABI (P = 0.007). In a logistic regression model the time rate index was associated with ABI, regardless of age (OR = 6.9, 95% CI = 1.1- 42.1; P = 0.04). In a multiple linear regression model, adjusting for age, SBP and diabetes, the time rate index was strongly associated with ABI (P < 0.01). None of the other indexes of BP variability were associated with ABI in univariate and multivariate analyses.CONCLUSION:Time rate index is a sensible method to measure BP variability by ABPM. Its performance for risk stratification of patients with hypertension should be explored in longitudinal studies.

This study investigated the effects of pedal frequency on the slow component of pulmonary oxygen uptake ( V O(2)) kinetics during heavy exercise at the same relative intensity. We hypothesized that higher pedal frequency (expected to enhance fast-twitch muscle fiber recruitment) would be associated with greater slow component amplitude (A' (s)), surface electromyography (normalized root mean square; RMS) and blood lactate concentration ([lactate]). Eight subjects performed square-wave transitions to heavy exercise at 35 and 115 rpm. Furthermore, alternated cadences square-wave transitions (35-115 rpm) were performed to examine the potential effects of additional fast-twitch muscle fiber recruitment on the slow component. Significance was accepted when P<0.05. The A' (s) was greater at higher cadences (0.58+/-0.08 and 0.70+/-0.09 L.min (-1) at 115 and 35-115 rpm, respectively) than at 35 rpm (0.35+/-0.04 L.min (-1)). Greater EMG increase over time (DeltaRMS ((10-3 min))) and [lactate] were observed at 115 and 35-115 rpm compared with 35 rpm. There was a significant correlation between A' (s) and overall DeltaRMS ((10-3 min)) for all pedal frequencies combined (r=0.63; P=0.001). Pedal frequency had no effect on time constants or time delays. These findings are consistent with the concept that progressive recruitment of muscle fibers is associated with the V O(2) slow component.

Objectives: There is a lack of studies regarding swallowing sounds in children 3 to 11 years of age. This study aimed to assess swallowing sounds by digital cervical auscultation in children of this age group without symptoms of oropharyngeal dysphagia. Methods: Digital cervical auscultation was performed in 118 subjects by use of a piezoelectric microphone. The children swallowed 5 mL of liquid and yogurt. The components of perceptual acoustic analysis were discrete initial signal (DIS), main signal of swallowing sound (MS), discrete final signal (DFS), and expiratory return (ER). Duration in seconds was the objective parameter of the swallowing sound signal analyzed. Results: Fifty-six boys and 62 girls were evaluated at a mean (±SD) age of 6.9 ± 2.03 years. A complete DIS-MS-DFS-ER swallowing sequence was found in 60% of the children. There was no significant difference in swallowing sound duration between both food consistencies (p = .189) or between genders either for liquid (p = .327) or yogurt (p = .792). There was no correlation between age and duration of the swallowing sound for liquid or yogurt. Conclusions: We concluded that digital cervical auscultation was able to provide objective information about the swallowing process that could contribute to methodological standardization in children.

OBJECTIVES:We tested the hypothesis that inspiratory muscle loading could result in exaggerated peripheral vasoconstriction in resting and exercising limbs and that inspiratory muscle training (IMT) could attenuate this effect in patients with chronic heart failure (CHF) and inspiratory muscle weakness.BACKGROUND:Inspiratory muscle training improves functional capacity of patients with CHF, but the mechanisms of this effect are unknown.METHODS:Eighteen patients with CHF and inspiratory muscle weakness (maximal inspiratory pressure <70% of predicted) and 10 healthy volunteers participated in the study. Inspiratory muscle loading was induced by the addition of inspiratory resistance of 60% of maximal inspiratory pressure, while blood flow to the resting calf (CBF) and exercising forearm (FBF) were measured by venous occlusion plethysmography. For the patients with CHF, blood flow measurements as well as ultrasound determination of diaphragm thickness were made before and after a 4-week program of IMT.RESULTS:With inspiratory muscle loading, CHF patients demonstrated a more marked reduction in resting CBF and showed an attenuated rise in exercising FBF when compared with control subjects. After 4 weeks of IMT, CHF patients presented hypertrophy of the diaphragm and improved resting CBF and exercise FBF with inspiratory muscle loading.CONCLUSIONS:In patients with CHF and inspiratory muscle weakness, inspiratory muscle loading results in marked reduction of blood flow to resting and exercising limbs. Inspiratory muscle training improves limb blood flow under inspiratory loading in these patients.